| Physical and emotional exhaustion | Chronic fatigue, elevated resting heart rate or blood pressure, recurrent illness, increased anxiety or depression | Reduced strength or stamina, chronic fatigue, recurrent illness, anxiety or depressive symptoms | A physician evaluation is warranted when burnout signs appear, particularly in a younger athlete who is new to the participation level |
| Reduced sense of accomplishment | Diminished performance or conditioning, low self-esteem, concentration or school-work difficulties | Performance and conditioning that level off or decline, cognitive difficulties, low self-esteem | If burnout continues or is reported after physical causes are evaluated, consider referral for psychological evaluation and care |
| Sport devaluation | Disinterest, moodiness, irritability, and fatigue that exhausts the motivation to keep participating | Reduced motivation to participate and possible withdrawal from sport | When concerns are raised by coaches or parents, or self-reported by the athlete, refer to a licensed mental-health provider when clinically indicated |
| Look-alike: non-functional overreaching | Training load builds without enough recovery, followed by a performance drop and a need for longer recovery; depressive symptoms may also be present | A performance decline after heavy training and insufficient recovery, sometimes with depressive symptoms | Evaluate athletes with depressive symptoms for non-functional overreaching and overtraining, recognizing that generally accepted diagnostic criteria are lacking |
| Look-alike: overtraining syndrome | Sport-specific performance decreases together with mood disturbance; emotional disturbances were self-reported by more than 70% of athletes with non-functional overreaching and overtraining syndrome | Underperformance that persists despite several weeks or months of recovery, plus persistent fatigue, mood changes, or sleep disturbance | Arrange a thorough medical and mental-health evaluation that considers sleep disorders, nutritional deficiencies, anemia, depression, anxiety, and eating disorders |
| Look-alike: major depressive disorder | Depressed mood, loss of interest or pleasure, changes in sleep, appetite or weight, impaired concentration, low energy, guilt, worthlessness, hopelessness, suicidal thoughts | Symptoms and impairment that spread beyond sport, rather than difficulties confined to training or competition | Refer for mental-health evaluation when depressive symptoms are present, particularly when they extend beyond sport or include suicidal thoughts |